University of California - San Diego, CA
posted 3 months ago
UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service. The Research Billing Quality Review Analyst oversees comprehensive audits of accounts with research charges submitted post-claim to Medicare, Medi-Cal, and Commercial insurance payers, as well as post-statement invoicing for research studies. Acting as the primary liaison to physicians, researchers, internal UCSD Health stakeholders, and patients, the incumbent ensures adherence to Medicare's Clinical Trial Policy, federal regulations, and contractual agreements with pharmaceutical and third-party entities. Additionally, the Specialist serves as a subject matter expert in research billing workflows and system processes, contributing optimization strategies. In addition to conducting audits, the Research Billing Quality Review Analyst synthesizes regulations and industry publications, assisting in the development of training materials and other departmental guidance documents. Operating autonomously, the Specialist conducts regular, ad hoc, and for-cause audits to ensure compliance with applicable federal and state laws, regulations, guidance, and internal policies and procedures. Furthermore, the Specialist provides detailed reports of findings and contributes to the development of corrective and preventative action plans.